Worldwide, diabetes mellitus (DM) is a growing healthcare challenge. Among the United States population overall, crude estimates for 2021 showed that approximately 38.4 million people of all ages (11.6 % of the population) have diabetes, 8.7 million adults aged 18 years or older (14.7 % of all adults) don't know they have diabetes and >97.6 million (28.7 %) have prediabetes. DM type 2 accounts for >90 % of diabetes cases [ ]. These facts are important because in the last 20 years, the number of adults diagnosed with diabetes has more than doubled as the American population has aged and become more overweight or obese. Furthermore, there has been a steady increase in age-standardized mortality rates from diabetes and in low-middle income countries the mortality rate due to diabetes has increased to 13 %. Furthermore, 48 % of all deaths caused by diabetes will occur before the age of 70 years. Conversely, the probability of dying from cardiovascular diseases, cancer or chronic respiratory diseases during the same period decreased by 22 %. Although diabetic kidney disease is the leading cause of chronic kidney disease and end-stage kidney disease worldwide, cardiovascular disease continues to stand as the primary cause of morbidity and mortality among DM patients. Patients with diabetes have more aggressive atherosclerosis, more diffuse coronary lesions, smaller coronary vessels, and more extensive disease that is associated with 2- to 4-fold increased mortality risk. Approximately 14–37 % of these patients will undergo coronary artery bypass graft (CABG) surgery and after coronary revascularization, patients with diabetes experience a higher mortality rate and greater need for repeat revascularization procedures [ ]. The global surge in DM type 2 cases, coupled with an escalating demand for coronary revascularization, underscores the intricate interplay between diabetes, cardiovascular disease, and acute and chronic kidney disease.